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A tour de force on the state of health care internationally

John Lister’s new book is an impressively researched 346-page book with 64 pages of bibliography. It is a comprehensive update of his first book on this subject published by Middlesex University Press in 2005 – Health Policy Reform – driving the wrong way?

Like its predecessor, it is a tour de force on the state of health care worldwide in the age of economic crisis and the neoliberal offensive. It is a unique combination of global analysis and comparison and campaigning handbook that contains a mass of information that you will not find elsewhere.

If you want know about the impact of the economic crisis and globalisation on health care services worldwide; if you want to know how this has played out across the globe from the USA and Canada to sub-Saharan Africa and Latin America this is the place to look. If you want to know about the World Health Organisation or the pernicious role of global financial institutions: the IMF, the World Bank, the OECD, and the European Central Bank this is where you can get it. If you want to know about the parasitic role and the impact of the pharmaceutical corporations this is the book you need.

John Lister presents all this in the framework of a working class/Marxist analysis of the capitalist system and the way it functions. In the section entitled Health care as a special type of commodity (page 26) he says the following :

“Capitalism is a system driven by the accumulation of capital, through the production and exchange of commodities. Commodities, as Marx analysed in Capital, embody two contradictory values: their use value, without which they would not be saleable in the market place; and their exchange value, defined by the hours of necessary labour time for their production (Marx 1870)…

“Health care shares with other commodities the combination of ‘use value’ (in this case additional family life, which for the patent remains the key factor). But since it is the product of human labour, embodying necessary hours of work (and in many cases access to modern, capital intensive ‘means of production’) it also embodies potential ‘exchange value’.”

He goes on to explain that health care is one of the worlds biggest and most profitable industries and its commodification potentially affects everyone on the planet at some time in their lives. Policy decisions affecting health care systems affect not only service users but the jobs, pay and working conditions of the staff employed in the industry and the vast numbers of often low paid workers providing the support services.

The book sets out the historical context of both the development of health services and the neoliberal backlash against them in Europe in particular. It analyses the development of health care in Britain from the launch of the NHS and the post war settlement to a myriad of ‘reforms’ and attacks on the NHS through to the assault on the NHS which is taking place today.

“One of the key historic periods of choice came in 1945, when Europe’s weakened and bankrupt ruling classes faced a new post-war political reality. They had to devise a new approach that could safeguard stability and rebuild a system that had been shattered and destabilised by war. The emergence of Keynesian economics and a ‘welfarist’ consensus in much of Europe reflected a new balance of class forces, in which capitalist classes found themselves having to deal with the expectations and demands of a more militant working class (reflected also in the strengthening of social-democratic and communist parties) which they were poorly placed to confront. Only the USA was largely unaffected by the new situation, its economy having been relatively untroubled by the war and its lack of even a social-democratic party of the working class helping to ensure that the post-war wave of trade union militancy remained largely confined to economic rather than political objectives. As a result, the divergences between the US and European politics continued to widen.”

Given John Lister’s many years as a leading health campaigner, you would expect a robust defense of the NHS and the principle upon which it was built and the book does not disappoint. It is both a champion of the principles of the NHS and a handbook for the struggle in Britain today to sustain healthcare free at the point of use in the face of the attacks by the Tory-led government.

To this end the book contains a comprehensive overview of the many attacks which have been launched against the NHS by successive British governments in the guise of ‘reforms’, not least the privatisation and other measures brought in by Tony Blair and Gordon Brown in the shape of PFI/PPP.

When it comes to alternatives, John Lister starts with socialist principles and the directly political problems of the fightback. With the collapse to the right of social democracy, he argues, it is the lack of an organised alternative to its left which hampers the fight back. He points to some welcome exceptions to this particularly in Greece with the rise of Syriza, which came very close to winning the last election on a platform of rejecting austerity and the restoration of health and other key public services. He also points to the Left Block in Portugal and the Red Green Alliance in Denmark.

He is critical of the radical left for its lack of prioritisation of the defence of heath care and points to the centrality of health care at both the industrial and political level and its potential to be at the centre of a wider fight back against austerity.

More specifically in terms of alternatives, he argues that public ownership and democratic planning not markets are the answer to effective healthcareand that the resources for this can be found given the political will to do so. He calls for the elimination of elitist opt outs for the wealthy. For the raising of a tax levy on the big financial institutions. For a Tobin Tax in international financial transactions. For steeply progressive income and corporation tax to raise the money for a decent health service. For the ending of tax evasion for the rich an for the corporations.

John Lister finishes by pointing to the centrality not only of resisting privatisation in the existing public health services but in the nationalisation of the drug companies and their research and development facilities. He puts it this way:

“But of course the biggest problem is a political one: securing governments with the commitment to pursue radical policies in the teeth of the massively powerful and well resourced lobby of the drug corporations (which in the US employ more than two lobbyists for every member of Congress). Few political parties even formally embrace the principles of nationalisation or in nay way challenge the drug companies, and few of those that do have any real intention of doing so. Even where drug companies are caught red handed in breach of the laws regulating their behaviour, they simply pay up even the biggest fine, make a ritual apology – and carry on in the same way.

Like its first edition, this much-expanded book is indispensible reading to all who want to understand the complexities of health care in order both to effectively defend what exists and to fight for something better as a part of the struggle for a socialist society.

Alan Thornett is a supporter of Socialist Resistance, which collaborates with the FI. His most recent book, “Militant Years: Car Workers’ Struggles in Britain in the 60s and 70s”, was published in 2010.